MEDICARE: SANDERS H. BERK, M.D. PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	DOO12529	MD

General Provider Information

NPI Number	:	1578789301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDERS H. BERK, M.D. PA

Provider Business Mailing Address
First Line	:	19221 MONTGOMERY VILLAGE AVE
Second Line	:	C-12
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886-5022
Country	:	US
Telephone Number	:	301-840-2266
Fax Number	:

Provider Business Practice Location Address
First Line	:	19221 MONTGOMERY VILLAGE AVE
Second Line	:	C-12
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886-5022
Country	:	US
Telephone Number	:	301-840-2266
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. CAROLE SUZANNE WEIKERT
Credential	:
Telephone Number	:	301-840-2266

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	08/22/2020

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